Compliance

OIG Exclusion Screening

An OIG exclusion screening searches the LEIE database to see whether a candidate is excluded from participating in federal and state healthcare programs for example Medicare and Medicaid programs.

What is the LEIE?

This acronym stands for the List of Excluded Individuals and Entities. Being on this list implies that a party is sanctioned from performing any services or providing goods associated with public healthcare programs.

How can employers determine whether an individual or entity is on the OIG exclusions list?

Warnings are not sent out when someone is entered into the OIG exclusions list. Instead, employers must perform a search of several databases to determine whether their employee is excluded.

Some databases that must be searched include; the Federal Office of the Inspector General’s Exclusion List database; SAM.gov; and each state’s Medicaid Exclusion Database. Some states may require employers to search other databases as well.

How do you perform an OIG exclusion screening search?

An OIG exclusion screening search involves several key steps, they are as follows:

1. The employer goes to the database they intended to search.
2. Then the employer enters their employee’s name and date of birth.
3. Now a list of potential matches will be presented. This list will contain all individuals with similar names and birth dates.
4. Employers now must check to see if the excluded person is, in fact, their employee.
5. For the best results, it is imperative that employers search for every version of an employee’s name, including their maiden names, combined names, and even shortened diminutives.

How many exclusion databases must be searched?

To avoid penalty, you must ensure that employees who handle state or federal health program participants do not fall onto any of the following exclusion databases:

• Office of Inspector General LEIE.
• The General Services Administration (GSA) Systems for Awards Management (SAM).
• State Medicaid Exclusion Lists.

Do you really need to search every state’s exclusion database?

Unfortunately, yes. While the OIG database includes most excluded persons, there are times when states exclude individuals for reasons that are not cited by federal law. The individuals reported for these reasons may not be reported to the OIG or other states immediately, meaning there could be a discrepancy in the OIG database.

To completely ensure compliance, it is necessary to perform a full-scale search every single month. Employers should not hesitate to do so, as this is a mandatory process required by the federal government.

How frequently must employers perform exclusion screening?

Employees’ absence from exclusion databases must be confirmed on a monthly basis.

How can you make the exclusion screening process easier?

Exclusion screening does not have to be tedious or time consuming. You can leverage specialized software to simplify the process, making bulk exclusion screening almost effortless. Consider using a software like Simplecheck to get the job done efficiently and effectively!

Are Sanctions and Exclusions different?

Are Sanctions and Exclusions different?

What happens if you employ an excluded party?

For organizations that participate in government health care programs, hiring an excluded individual or entity is illegal. Companies that violate these terms may be subject to substantial fines, ranging between $30,000 and $300,000.

If an employer was unaware that an employee was excluded, are they liable?

Absolutely. The courts will not accept ignorance as a viable excuse for hiring an excluded individual. This is why the exclusion screening process is mandatory. By performing regular searches across all databases, employers can avoid employing excluded individuals.

Can employers recover reimbursement for services administered by excluded persons?

An organization may not recover reimbursement from any federal healthcare program when the services administered were performed by an individual who was excluded from engaging with public healthcare program participants.

What happens if you fire someone who was not actually on the exclusion list?

Because there are often identical names featured in exclusion screening searches, many employers make the mistake of firing individuals who were not actually excluded. Yet, it is the employer’s responsibility to confirm that the person featured on the list is actually the person they have hired. For this reason, false positives that lead to a firing can result in a lawsuit levied against the employer by the terminated employee.

How can you validate the identity of someone featured on the exclusion screening list?

To avoid false positives and lawsuits, validating the identity of individuals you believe to be featured on the exclusion list is essential. Verifying their identity can be done using the following information:

• Their date of birth.
• Their address.
• Their Social Security Number.

Who is responsible for overseeing OIG Exclusions?

The Office of Inspector General (OIG) is directly responsible for overseeing OIG exclusions. This government entity is a component of the Department of Health and Human Services (HHS). Their role is to prevent healthcare fraud, waste, and abuse by implementing OIG exclusions.

Who can be subject to OIG exclusion?

Many individuals are subject to OIG exclusion. For example, any individual or entity that has been convicted of certain crimes may be placed onto the OIG exclusions list. Exclusions are most likely to affect Doctors, Physician’s Assistants, Registered Nurses, Licensed Nurses, Therapists, and a number of other healthcare professionals.

What are the types of exclusions that someone may be subject to?

Potential exclusions fall into two categories; Mandatory Exclusions and Permissive Exclusions. Here is more about each:

• Mandatory Exclusions - Individuals who unlawfully distribute controlled substances, abuse patients, or commit healthcare fraud and crimes will be subject to Mandatory Exclusion for a minimum of five years.
• Permissive Exclusions - Individuals may be subject to Permissive Exclusion due to loss of state license to practice; failure to repay student loans; conviction of certain misdemeanors; failure to provide quality care; or one of several other misdemeanors.

How long are individuals on the OIG exclusions list?

If you are subject to a Mandatory Exclusion, it may last for five or ten years for the first and second offenses. If you have a third offense, the exclusion will be permanent.

Permissive Exclusions last for an amount of time that is decided by the OIG. Therefore, Permissive Exclusions can last between one and three years, or more.